Stewart Merrill H, Morin Daniel P
John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
Card Electrophysiol Clin. 2018 Mar;10(1):99-109. doi: 10.1016/j.ccep.2017.11.008.
Periprocedural management of anticoagulation for cardiac device implantation has evolved over the past 20 years. The traditional paradigm of vitamin K antagonist interruption with heparin bridging has now been shown to be less safe than continuation of vitamin K antagonists at therapeutic levels. Dual antiplatelet therapy during device implantation poses substantial risk but is often necessary. The safest dosing strategy for newer direct oral anticoagulants is still not clear.
在过去20年中，心脏设备植入术中抗凝的围手术期管理不断发展。传统的维生素K拮抗剂中断并使用肝素桥接的模式，现已证明不如在治疗水平持续使用维生素K拮抗剂安全。设备植入期间的双联抗血小板治疗存在重大风险，但往往是必要的。新型直接口服抗凝剂最安全的给药策略仍不明确。
